Abstract：
STUDY OBJECTIVE:We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors. METHODS:The study was performed at a large, tertiary care, academic children's hospital. Patients who returned to the ED within 72 hours of a previous visit were identified by computerized registration data. The charts of these patients were then reviewed by a member of the ED medical staff to identify factors from the initial visit that contributed to the return visit. A multidisciplinary committee then reviewed each case until consensus was achieved regarding the cause for the repeat visit. In this study, we analyzed the quality improvement decisions from a 12-month period. RESULTS:Over a 12-month period, during which there were a total of 51,195 visits, 285 (0.56%) patients were hospitalized after a repeat visit. The repeat visit was determined to be unrelated to the first visit in 12 (4.2%) patients. In 12 (4.2%) cases, the cause for repeat visit and hospitalization could not be determined. This resulted in a total of 261 patients for analysis. In 234 (90.0%) patients, the return visit was determined to be a result of the progression of illness (no medical error). Ten (3.8%) patients had a missed diagnosis, whereas 2 (0.8%) patients had errors in their treatment (likely medical error). An incomplete workup was cited in 7 (2.7%) patients (potential medical error). Parenting factors (refusing admission, not filling prescriptions, not giving prescribed medications) were noted in 5 (1.9%) cases. Three (1.1%) patients did not follow up with appropriate subspecialists. CONCLUSION:The overall rate of repeat visits resulting in hospitalization is small. In the majority of these cases (90.0%), the ED evaluation was appropriate and the admission was for progression of the patient's illness. Given the small number of patients and the infrequency of missed diagnoses, this may not be an efficient method for assessing ED performance.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Depiero AD,Ochsenschlager DW,Chamberlain JMdoi
10.1067/mem.2002.116595subject
Has Abstractpub_date
2002-02-01 00:00:00pages
159-63issue
2eissn
0196-0644issn
1097-6760pii
S0196064402429241journal_volume
39pub_type
杂志文章abstract：STUDY OBJECTIVE:Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can ...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章
doi：10.1016/j.annemergmed.2010.01.033
更新日期：2010-08-01 00:00:00
abstract：STUDY OBJECTIVE:Patients who leave before being seen by a physician represent a significant problem for many emergency departments (EDs). We sought to determine the effect of a new ED rapid entry and accelerated care at triage (REACT) process on the frequency of patients who leave before being seen. METHODS:We conduct...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2005.06.013
更新日期：2005-12-01 00:00:00
abstract：STUDY OBJECTIVE:We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. METHODS:We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive ...
journal_title：Annals of emergency medicine
pub_type： 临床试验,评论,杂志文章,多中心研究
doi：10.1016/j.annemergmed.2012.11.009
更新日期：2013-08-01 00:00:00
abstract：:Blunt abdominal trauma is a common presentation to the emergency department. Ischemic colitis is a rare complication of this and its possible sequelae are important for an emergency physician to recognize. A 21-year-old man presented to the emergency department with abdominal pain and hourly episodes of bright red blo...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2011.01.014
更新日期：2011-08-01 00:00:00
abstract：:Ten healthy male volunteers were studied to compare the effects of simultaneous versus sequential inflation of antishock trousers (AST) and simultaneous inflation pressures of 20, 40, and 100 mm Hg on blood volume displacement centrally. Radioisotope scans were used to determine the change in blood volume distribution...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(85)80877-5
更新日期：1985-07-01 00:00:00
abstract：STUDY OBJECTIVE:We identify measures of emergency department (ED) and hospital workflow that would be of value in understanding, monitoring, and managing crowding. METHODS:A national group of 74 experts developed 113 potential measures using a conceptual model of ED crowding that segmented the measures into input, thr...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/S0196064403008163
更新日期：2003-12-01 00:00:00
abstract：STUDY OBJECTIVE:Epinephrine autoinjector use for anaphylaxis is increasing. There are reports of digit injections because of incorrect autoinjector use, but no previous reports of lacerations, to our knowledge. We report complications of epinephrine autoinjector use in children and discuss features of these devices, an...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2015.07.011
更新日期：2016-03-01 00:00:00
abstract：:Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Methemoglobin cannot carry oxygen or carbon dioxide. Methemoglobinemia can result from exposure to a wide variety of chemicals, including many commonly prescribed drugs, usually in an overdose situation. Most cases require only...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(82)80502-7
更新日期：1982-04-01 00:00:00
abstract：STUDY OBJECTIVE:We develop a comprehensive view of aspects of care associated with parental satisfaction with pediatric emergency department (ED) visits, using both quantitative and qualitative data. METHODS:This was a retrospective observational study using data from an institution-wide system to measure patient sati...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2013.04.025
更新日期：2013-10-01 00:00:00
abstract：:The traditional use of the American ED, one of unrestricted access by patients and payment for services by insurers, is being questioned in this era of health care reform. Both primary care physicians and managed care organizations have questioned the use of the ED by patients without obvious problems of an emergency ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(97)70164-1
更新日期：1997-09-01 00:00:00
abstract：:Several clinical studies have yielded conflicting results in examining the effectiveness of bystander CPR (BCPR). The purpose of this pilot study was to determine the effectiveness of BCPR in an animal model of cardiac arrest and resuscitation. Ten swine were instrumented for hemodynamic and regional blood flow measur...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(05)81561-6
更新日期：1990-08-01 00:00:00
abstract：:Traumatic dislocation of the hip joint is relatively uncommon in children. The trauma required to produce a dislocation can vary from minimal to severe, high-energy force. We report a case of posterior hip dislocation in a 9-year-old boy who received relatively minor trauma to his leg but who did not seek medical atte...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(87)80298-6
更新日期：1987-01-01 00:00:00
abstract：:Myocardial rupture is a catastrophic complication of acute myocardial infarction that usually results in sudden death. If diagnosed quickly, patients with myocardial rupture may be salvaged. This report describes the application of emergency department two-dimensional echocardiography in the diagnosis of six cases of ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(94)70361-2
更新日期：1994-06-01 00:00:00
abstract：:We conducted a study to assess the efficacy of the dipstick leukocyte esterase test (LET) in the detection of cerebrospinal fluid (CSF) leukocytosis as a quick screen for bacterial meningitis. Nine hundred forty-two CSF samples were collected from 800 patients. The LET was compared in a double-blinded fashion with rou...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章
doi：10.1016/s0196-0644(89)80058-7
更新日期：1989-11-01 00:00:00
abstract：:In experimental animal studies, opiate receptor antagonists (such as naloxone) and physiological opiate antagonists (thyrotropin-releasing hormone [TRH] have been used with some success to improve outcome and physiological variables following traumatic shock associated with hypovolemia, spinal cord trauma, and head in...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(86)80944-1
更新日期：1986-12-01 00:00:00
abstract：:Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ong...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2016.03.016
更新日期：2016-10-01 00:00:00
abstract：:One hundred forty-one medical schools were surveyed to determine the emergency medicine core content topics and skills being taught in the curricula. Responses were obtained from 96 schools through two mailings and a telephone followup. Most topics surveyed were offered in the vast majority of medical schools (greater...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(86)80478-4
更新日期：1986-01-01 00:00:00
abstract：:Annals' 25th anniversary is a cause for celebration, but the future imposes a new set of ethical questions and moral dilemmas for emergency physicians. Each physician will need to make personal choices consistent with the courage, judgment, integrity, and dedication of past leaders when dealing with the moral dilemmas...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(97)70035-0
更新日期：1997-12-01 00:00:00
abstract：:Cocaine use and abuse continue to overwhelm urban economic, social, and health care systems. Patients frequently present to the emergency department with life-threatening manifestations of cocaine use, including trauma, acquired immune deficiency syndrome, psychomotor agitation, and cardiovascular collapse. Adequate t...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(05)81217-x
更新日期：1991-02-01 00:00:00
abstract：:WHAT IS ALREADY KNOWN ON THIS TOPIC: Previous out-of-hospital studies indicate that selective spinal immobilization may miss patients with cervical injury. WHAT QUESTION THIS STUDY ADDRESSED: Can paramedics apply the Canadian C-Spine Rule in alert, stable, cooperative, blunt-trauma patients to reserve spinal immobiliz...
journal_title：Annals of emergency medicine
pub_type： 评论,杂志文章
doi：10.1016/j.annemergmed.2009.09.015
更新日期：2009-11-01 00:00:00
abstract：STUDY OBJECTIVE:To describe the experience of croup at Princess Margaret Hospital for Children (PMH), the only tertiary pediatric hospital in Western Australia, from 1980 through 1995 with reference to the introduction of routine steroid treatment in the ICU in 1989, in the general hospital wards from 1989 through 1993...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(96)70084-7
更新日期：1996-12-01 00:00:00
abstract：:From 1995 to 2000, the National Highway Traffic Safety Administration (NHTSA) sponsored an initiative to create and operate an Automatic Collision Notification (ACN) system on a demonstration basis in a rural area to provide faster and smarter emergency medical responses and in an attempt to save lives and reduce disa...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1067/mem.2001.118454
更新日期：2001-10-01 00:00:00
abstract：:Sound scientific information with which to determine the true efficacy of zidovudine for prophylaxis will probably not be available soon. Physicians should educate themselves thoroughly on the issues. It is highly recommended that thoughtful discussions of the issue of transmission of HIV from health personnel to pati...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(05)81079-0
更新日期：1991-12-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the safety and efficacy of a systematic evaluation and triage strategy including immediate resting myocardial perfusion imaging in patients presenting to the emergency department with chest pain of possible ischemic origin. METHODS:We conducted an observational study of 1,187 consecutive pa...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(97)70317-2
更新日期：1997-01-01 00:00:00
abstract：:During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the cou...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：
更新日期：1998-02-01 00:00:00
abstract：STUDY OBJECTIVE:Researchers from low- and middle-income countries have limited access to publishing and editing resources. This study describes a journal-initiated platform to improve publication quantity and quality in Sub-Saharan Africa emergency care research: Author Assist. METHODS:This is a descriptive report of ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2016.09.011
更新日期：2017-04-01 00:00:00
abstract：:Massive hemoptysis is an uncommon but life-threatening emergency. The loss of at least 600 mL of blood within a 48-hour period has been associated with a high mortality rate. Initial stabilization including airway and ventilation management, IV fluids, oxygen, and laboratory and radiographic studies should be done in ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(87)80686-8
更新日期：1987-05-01 00:00:00
abstract：:The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2010 annual report on the status of US emergency medicine training programs. ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2010.03.022
更新日期：2010-05-01 00:00:00
abstract：:Airway compromise is the most common cause of death and severe morbidity in acutely ill and injured children. Rapid-sequence intubation (RSI) is a technique for emergency airway control designed to maximize successful endotracheal intubation while minimizing the adverse physiologic effects of this procedure. RSI requi...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(96)70140-3
更新日期：1996-07-01 00:00:00
abstract：:Acid-base changes occurring during cardiac arrest and subsequent CPR are related to a complex low-perfusion state characterized clinically by venous and tissue hypercarbic and metabolic (lactic) acidosis. This low-flow state is a dynamic process dependent on the time intervals between onset of arrest, initiation of CP...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(05)80471-8
更新日期：1993-02-01 00:00:00
